COVID19 Home Management HandBook Version 3 (15june2020)

Home-Management of Mild Cases
COVID-19 Released Sunday 14 June 2020

Mobile Version 3.0
If you are suspecting COVID19, have been in

contact with a COVID19 confirmed case, or are
waiting for COVID19 test results- these handy
guidelines will help you in managing at home
and preventing the spread of virus to others.
Version 1.0 released Wednesday, 1 April 2020

Version 2.0 released Monday 27 April 2020
LIST OF CONTENTS
............................................................................................................................. 1
List of Contents .................................................................................................... 1
Note ..................................................................................................................... 2
Contributors ........................................................................................................ 2
Objective of the Document .................................................................................. 3
1. Introduction ........................................................................................... 3
1.1. Knowing COVID-19 symptoms ......................................................... 3
1.2. Who is at risk? ................................................................................. 4
1.3. How to avoid getting infected? ........................................................ 4
2. COVID-19 Management .......................................................................... 4
2.1. Confirming Signs and Symptoms ...................................................... 4
2.2. What to do if you have a suspected or confirmed COVID19 case at
home? 5
2.2.1. Immediate Actions ............................................................. 5
2.3. For the first seven days .................................................................... 5
2.3.1. Make arrangements for a separate room ........................... 5
2.3.2. Positioning and Breathing ................................................... 6
2.3.3. Clinical Care ........................................................................ 6
2.3.4. Food Management & Utensils Handling ............................. 8
2.3.5. House-Keeping Instructions ................................................ 9
2.4. After first seven days ....................................................................... 9
3. Managing Contacts ............................................................................... 10
4. Recovering after COVID-19 ................................................................... 10
5. COVID19 – Special Case Management .................................................. 11
5.1. COVID-19 in Children ..................................................................... 11
5.2. COVID19 in Pregnant Women ........................................................ 11
Practical & Handy Handbook | Living in the Times of COVID-19 | Mobile Version 3.0
5.3. COVID-19 and Breast-Feeding ........................................................ 12
Annexure ........................................................................................................... 13
Annex 1 - List of Essential Items to Stock ..................................................... 13
Annex 2 - Wearing Personal Protection Equipment (PPE) ............................ 14
Annex 3 - Wearing the Mask ....................................................................... 15
Annex 4 - Removing Personal Protection Equipment (PPE) ......................... 16
Annex 5 - List of websites to follow and stay updated ................................. 16
Annex 6 - Managing Breathlessness at home .............................................. 17
Annex 7 - Positions to Manage Breathlessness ............................................ 18
Annex 8 - Breathing a rectangle................................................................... 18
Annex 9 - Exercises to clear chest ................................................................ 19
Annex 10 - Positions to keep chest clear .................................................. 19
Annex 11 - Sleeping Tips .......................................................................... 20
Annex 12 - Other resources for Mental Health ........................................ 20
Annex 13 - Advice for parents during COVID19 ........................................ 21
Annex 14 - Getting Tested ....................................................................... 21
Annex 15 - List of Documents and Guidelines Reviewed .......................... 23
1
NOTE
This handbook has been developed by the listed contributors after reviewing the
listed documents and guidelines by WHO, CDC, ECDC and other leading public
health institutions and experts for home care (See Annex 15). However, it is
important to understand that COVID-19 is a novel disease with rapidly evolving
protocols for precautions, quarantine and isolation. For latest research and
updates, please refer to WHO’s guidance and advice.
The helplines and apps mentioned in this handbook are specific to Pakistan.
This is the third version of this handbook, which also incorporates practical tips
from COVID19 Survivors, Care Providers and Family Members.
CONTRIBUTORS
CONTRIBUTORS
Prof. Nighat Mir Ahmed, Professor of Rheumatology, National Hospital, Adjunct Faculty
UHS, FJMU, Gulab Devi Hospital, Member FJOG, Chair ACF
Dr. Shabnum Sarfraz, Member Social Sector, Planning Commission, Government of
Pakistan
Dr. Saira Elaine Anwer Khan, Assistant Professor Rheumatology, FMH, ACF
Dr. Naveed Syed, Consultant Communicable Disease Control, Public Health England
Dr. Sumaira Farman Raja, Professor of Rheumatology, National Hospital, FJMU, Gulab Devi
Hospital, Adjunct Faculty Cochair ACF
Dr. Ayesha Mian, DFAACAP, SFHEA, Adult, Child and Adolescent Psychiatrist, Associate
Professor & Past Chair, Department of Psychiatry, Founding Dean of Students of the Office
of Student Experience, Aga Khan University.
Dr. Ahmed Saeed, Associate Professor Rheumatology, Gulab Devi Hospital, Secretary ACF,
Adjunct Faculty FJMU
Dr. Samia Latif, Consultant in Communicable Disease Control
Dr. Roomi Aziz, Technical Lead Health Data and Communication, P2impact
Dr. Tanya Soomro, Consultant Paediatrician, Lahore Children’s Centre
Dr Aisha Sanober, FCPS, Adult Psychiatrist; Fellow, Child and Adolescent Psychiatry, Aga
Khan University.
Dr. Parveen Ali, Senior Lecturer, Sheffield University
Sidra Bashir, Public Health Associate, P2impact
Bilal Majeed, COVID19 Secretariat, Planning Commission
EDITING, REVIEW AND COMPILATION
ACKNOWLEDGMENTS
Friends of Arthritis Care Foundation
Hyder Omar
Noor Ahmad
2
OBJECTIVE OF THE DOCUMENT
This document provides information and guidance for the public (with no
health/medical background) on management of stable COVID-191 cases (with mild
symptoms as elaborated later) at home.
1. INTRODUCTION
1.1. KNOWING COVID-19 SYMPTOMS
The following symptoms may appear within 2-14 days of exposure.
SIGNS AND SYMPTOMS

Most Common Less Common Rare
 Fever  Body Aches  Loss of
 Cough (with or  Sore throat/ itching in throat appetite
without sputum)  Muscle pain and Body Aches  Headache
 Tiredness/  Difficulty in breathing /  Nausea
Fatigue shortness of breath  Vomiting
 Burning Eyes  Skin rash
 Blocked or Runny Nose  Diarrhoea
 Loss of smell
EMERGENCY WARNING SIGNS
 Increasing difficulty in breathing (especially if sudden onset)
 Persistent pain/ heaviness in chest
 Worsening ability to concentrate or confusional state
 Bluish lips or face
1
COVID-19 is a novel Coronaviruses (CoV) strain first surfacing in December 2019, spreading via cough and sneeze
droplets.
3
It is critical that medical help is sought immediately in case of emergency
warning signs, as this may rapidly progress into any of the clinical syndromes
associated with COVID-19 (pneumonia, severe pneumonia, Acute Respiratory
Distress Syndrome (ARDS), sepsis, septic shock). In case of emergency signs,
immediately call the Government of Pakistan COVID-19 Helpline +92 300 111
1166 and/or visit a government designated public or private hospital.
1.2. WHO IS AT RISK?

While everyone is at risk, some are more vulnerable and may become more
severely ill, if infected. These include:
 Patients aged 60 years and older
 Pregnant women
 Patients with history of long-term (chronic) medical conditions such as
diabetes, high blood pressure and heart conditions, HIV, Cancer, asthma or
any condition affecting breathing or lowering immunity.
1.3. HOW TO AVOID GETTING INFECTED?

Multiple acronyms are now being coined for advocacy around COVID-19. These
include avoiding the three C’s: Closed spaces with poor ventilation, Crowded
spaces and Close-contact settings such as close-range conversations.
2. COVID-19 MANAGEMENT
2.1. CONFIRMING SIGNS AND SYMPTOMS
 If you are experiencing any of the mild signs and symptoms listed earlier,
call your doctor or any of the following helpline numbers for advice.
Federal 1166, 115 (Edhi)

Punjab 0800 99000, 0301-1102229, 042 99231669, 042 99231670, 1122
Sindh 021 99204405/0316-0111712
Balochistan 1166
KPK 1700
 Follow the instructions provided through the helplines, and if
recommended, get tested for COVID-19. See Annex 14 for details on
testing.
 Do not hesitate from getting tested due to fear of being moved to a
Quarantine Centre. Due to the rising number of cases, the Government has
now allowed home isolation and home management of positive cases and
is NOT asking positive cases to move to the Government Isolation Centres.
Only those patients who cannot afford to manage home isolation, and ask
for a government isolation space, are being guided to the Government
Isolation Centre.
 If you go to a laboratory for a test, take essential precautionary measures
i.e. wear a mask, avoid touching surfaces, use sanitizer and maintain safe
distance i.e. minimum of six feet or two metres.
4
 Consider yourself/ family member as COVID-19 positive, and exercise all
the necessary precautions, including self-isolation as you wait to receive the
results.
2.2. WHAT TO DO IF YOU HAVE A SUSPECTED OR CONFIRMED

COVID19 CASE AT HOME?
If you have a confirmed or suspect case of COVID19 at home, please confirm that
the symptoms are mild, and the patient is not a high-risk case (as specified in 1.2).
High-risk patients can also be managed at home, but you should be in touch with
your doctor, so that if their condition deteriorates, they can be taken to hospital
immediately.
2.2.1. IMMEDIATE ACTIONS

 For most people, symptoms last 7-14 days and will be mild. However, this
will require isolation. Stock up on the essential items listed in Annex 1 that
you will need to manage a COVID-19 positive or suspect case at home.
 Call government or private hospitals in your city to confirm if they are
managing COVID19 patients so that you know where to go to in case of an
emergency
 Call your physician/ doctor for timely advice
 Get in touch with people with whom the patient may have been in contact
with over the last 7 days. Ask them to monitor their symptoms for at least
14 days after their contact with the confirmed patient.
 Download COVID-19 Govt of Pakistan Application (click here), which has a
feature called Pak Nigehbaan. This feature shows the nearest hospitals and
the status of beds and ventilators available.
2.3. FOR THE FIRST SEVEN DAYS

COVID19 confirmed/ suspected patients must isolate for at least seven days even if
they feel well. This is critical so that they do not pass the infection on to other
people.
It is also important to prepare the patient for expected symptoms i.e. body aches
and pain, fever spikes, diarrhoea, breathlessness on little or no exertion, loss of
hunger. Most of these symptoms will settle down in 4-6 days. Clinical care has been
detailed in section 2.3.3. For isolation, following instructions need to be followed.
2.3.1. MAKE ARRANGEMENTS FOR A SEPARATE ROOM

 Isolate preferably in a room with attached bathroom and adequate
ventilation (windows).
 Remove all non-essential furniture and items from the room.
 Place a table outside the room where all hygiene and house-keeping
supplies dedicated for patient’s care can be stored. See Annex 1 for the list
of essential items.
 Keep dedicated thermometer, pulse oximeter and BP apparatus inside the
room to regularly assess patient’s health.
5
 Equip the room with spare change of patient’s clothes and bed linen (bed
sheets & pillowcase) for 7-10 days
 Caregiver can enter room only after wearing personal protection
equipment (PPE) in the prescribed order; and discard all disposable items
after leaving the room. See Annex 2, 3 and 4 for correct way to wear and
remove PPE and wearing mask/ respirator. When care-giver enters the
room, patient must also be wearing a mask.
2.3.2. POSITIONING AND BREATHING

 Rest and avoid routine chores like making bed that may cause exertion and
breathlessness
 Initially you may get breathless even on sitting for short periods. Try and
avoid breathlessness by lying down in prone position as much as possible.
 Do breathing exercises. See Annex 6, 7 and 8 for breathing exercises and
managing breathlessness at home. Also watch:
https://www.youtube.com/watch?v=bBkGDIeQwXo&feature=emb_title
by BBC London on breathing for COVID19 patients
 Keep items like mobile charger, medicines, water bottle, dustbin etc close
to the bed to avoid unnecessary exertion.
 Avoid taking phone calls or talking too much to avoid exertion and
breathlessness.
2.3.3. CLINICAL CARE

RECORDING VITALS
Many patients will be asymptomatic or have mild symptoms.
For patients who are high risk or are more unwell, vitals (heart rate, breathing
rate, temperature, blood pressure and oxygen saturation) can be checked every
4-6 hours to see any of the following emergency signs or symptoms:
Vitals Emergency Signs
Oxygen saturation Less than 94 percent
Respiratory Rate More than 30 breaths/ min
Pulse Rate More than 110 beats/ min
Blood Pressure Less than 100/60 mm HG
Unable to speak in full sentences
Increasing confusion
If any of these signs are present, call the helpline/ your doctor for advice. In case
of abnormal vitals, monitor and measure again every 30 minutes. Be prepared
for hospital admission.
MANAGING COVID-19 SPECIFIC MEDICINES
 Please consult a doctor for treatment protocol and diagnostic tests.
 Do not self-medicate i.e. do not take medicines without consulting a doctor
 In the following are the medications and dosage being following by COVID-
19 confirmed cases for home management:
 For fever, headache and body aches: Tab Panadol/ Paracetamol 500
mg. You can repeat in case of fever every six hours for a maximum of
three times a day.
 For cough or throat irritation: Tab Azithromycin 500 mg twice a day
for five days
 For cough with sputum or post-nasal drip: Acetylcysteine 200mg
powder/soluble granules (locally available as Mucolator) dissolved in
water once a day
 For nasal decongestion: Steam inhalation through nose, or
nebulization with normal saline once a day. Patients have also
6
reported relief when adding 1 tsp Vicks Vaporub to boiling water and
inhaling the steam. Also see Annex 9 and 10 for exercises to keep
chest clear.
 To avoid coagulation: Tab Aspirin/Loprin 150 mg once a day
 For diarrhoea: ORS sachets dissolved in water 2-3 times a day
 For immunity: Multi-vitamins (C, D3 and Zinc for immunity) once a
day
 For allergies with respiratory symptoms – Tab Montelukast 10 mg
once a day (at night)
 For allergic rash – Tab Loratadine 10 mg once a day
 To keep nostrils moist if dried – one drop of olive oil in each nostril
twice a day
LABORATORY TESTS
 Get tested for Complete Blood Profile (CBC), D-Dimers, Pro-Calcitonin,
Serum Ferritin, Serum LDH and CRP.
 If any of the tests are altered/abnormal, repeat the test in two days. If the
results continue to deteriorate, call your doctor or the helpline.
MENTAL HEALTH
Stress is a normal response to a difficult situation. Feeling stressed and worried
while suffering from symptoms of COVID-19 is natural. Signs of stress may include:
 Inability to concentrate
General
 Persistent negative feelings
symptoms
 Constant worrying
 Feeling unhappy, moody, or angry
Emotional
 Feeling overwhelmed
symptoms
 Feeling lonely and alone
 Aches and pains

Physical
 Nausea
symptoms
 Dizziness
 Rapid heart rate
Behavioural  Eating more or less
symptoms  Sleeping too much or too little
 Withdrawing from others
These symptoms may fluctuate over time and may also be experienced by people
taking care of COVID-19 patients. If symptoms become severe (see below) and
affect your daily functioning then it is important to immediately consult a
specialist.
Signs of Serious Distress:
 Inability to take care of self or others
 Not knowing name, where they are from, what is happening
 Feeling consistently fearful, angry, or withdrawn
 Thoughts of wanting to die
 Thoughts of wanting to hurt themselves
 Threatening to hurt others
Ways to take care of mental and emotional wellbeing
 Maintain Routine
 Keep regular routines and schedules
 Exercise regularly, keep regular sleep routines and eat healthy food.
For COVID-19 patients this can slowly begin once they feel better
 Sleep regularly for at least eight hours a day. Also see Annex 11 for
sleeping tips.
7
 Practice deep breathing, meditation or mindfulness for a few
minutes every day
 Stay Connected
 Keep in touch with friends or family members but must not exhaust
yourself
 Use video-chats to chat with your family taking care of you
 Stay in touch with friends and family over WhatsApp /text messages
 Self-Care
 Pay attention to your own needs and feelings
 Make a daily list of things you are grateful for
 Do a daily activity, you enjoy or find meaningful or relaxing
 Listen to music, radio, audiobooks or podcasts
 Read a book
 Avoid watching news or social media to manage anxiety
Patients with pre-existing mental health disorders are at higher risk of
experiencing an exacerbation of their symptoms. They should ensure the
continuity of care with their physician, maintain adherence to their treatment
plan and be alert to the signs of relapse.
2.3.4. FOOD MANAGEMENT & UTENSILS HANDLING

 Dedicate a set of essential utensils and keep inside the isolation room
(plate, spoon, fork, glass, mug, jug, bowl etc.)
 Receiving food in the room
 Place washed and dried utensils outside the room on the table and
close the door.
 Family members should put food into the utensils without touching
it and leave.
 Pick the utensils filled with food without touching the surfaces and Practical & Handy Handbook | Living in the Times of COVID-19 | Mobile Version 3.0
take it into your room to eat.
 Wash dirty utensils with detergent in the washroom and dry them using
tissue papers.
 If care-giver is washing the dishes, caregiver must wear gloves and mask,
and avoid spillage and splashing of water as much as possible.
ENSURING NUTRITIOUS DIET

 Take a daily nutritious and balance diet at regular meal timings.
 Take freshly prepared meals
 Diet may include:
 At least 1 egg
 At least 2 cups of fruits (dates, apricots, mangoes etc.)
 At least 2.5 cups of vegetables
 At least ¾ cup of grains
 At least 1 serving of meat/ beans
 At least 8 – 10 glasses of water
 In addition to water, add drinks to daily diet, such as:
 Apple and ginger juice
 Lemon in warm water
 Honey and lemon drink
 Milk shakes
 Turmeric in milk
 Green tea with cinnamon, cloves, ginger, lemon and honey
 Joshanda
 Take vitamins
 Tab Zinc or Syp Zental/Zincat 1 tablespoon daily
 Vitamin B complex 1 daily (surbex or neurobion)
 Vitamin C (Ca C 1000 in water)
8
 Vitamin D3 1 daily
2.3.5. HOUSE-KEEPING INSTRUCTIONS
House-keeping instructions must be followed carefully, due to the reason that the
coronavirus droplets are known to survive on different surfaces for varying
durations. To elaborate this, house-keeping, laundry and related instructions have
been elaborated below. Both Alcohol2 and Bleach3 can be used for disinfection.
CLEANING THE ROOM DURING ISOLATION

 Clean all surfaces in the room with disinfectant
 Do not use broom or dry dusting as this may create aerosols.
 Use damp cleaning methods with Alcohol or Bleach solutions as given in the
footnotes. This includes wet mopping for the floor and wet rags to wipe
surfaces.
 If caregiver is cleaning the room, she/he must wear PPE
LAUNDRY
 Place dirty/ contaminated linen directly into a laundry bag/ plastic liner and
place outside the isolation room.
 Instructions for un-infected family members:
 Wear gloves when collecting the bag.
 Collect the plastic bag containing the dirty clothes, and empty the bag
into the washing machine or a tub. The clothes should be washed with
gloves on.
 Ensure that clothes of COVID-19 patient are not touched by other
people in the house. In that case, it happens, the attendant must
remove his/her clothes immediately and put them for washing.
 Wash the laundry with regular detergent in water at 70 °C (160 °F) for
at least 25 minutes.
 Disinfect all surfaces of washing machine after handling laundry of

COVID-19 positive cases
 In case of hand-washing, wear PPE with latex gloves.
 Regularly dispose-off laundry for washing.
WASTE MANAGEMENT
 Place used supplies and garbage waste, including used gloves and masks,
directly into garbage bags in the isolation room.
 All waste material must be double-bagged. Once a garbage bag is three-
quarters full, tie the bag. Place the first bag in a second bag, which should
also be tied and place it outside the isolation room.
 Family members/ attendants must wear gloves when collecting the garbage
bag and disposing it.
2.4. AFTER FIRST SEVEN DAYS

COMING OUT OF ISOLATION
Check if the symptoms have resolved (defined as no fever without use of fever-
reducing medications and improvement in respiratory symptoms) and decide
accordingly.
 If the symptoms are still present, isolation must continue.
2
Alcohol, specifically Ethyl Alcohol (70%) is effective against influenza virus, can can be used to disinfect small
surfaces (e.g. rubber stoppers of multiple-dose medication vials, and thermometers) and occasionally external
surfaces of equipment (e.g. stethoscopes and ventilators).
3
Diluted household bleach disinfects within 10–60 minutes contact time, is widely available at a low cost, and is
recommended for surface disinfection. If liquid bleach is available, one part of liquid bleach and nine parts of water
make 0.5% chlorine solution, which can be used for disinfection of all clothes, surfaces or anything, by applying for
at least 10 minutes.
9
 If the symptoms have resolved:
 Remain isolated/in quarantine for an additional two weeks after the
symptoms resolve, and then end home isolation.
OR
 Get tested for COVID19. If PCR is negative twice on samples collected
24 hours apart, it can be assured that the patient is not infective
anymore. End home isolation.
CLEANING/DECONTAMINATING THE ROOM AFTER ENDING ISOLATION

Once the patient has recovered and can leave the room:
 Disinfect all surfaces that patient may have come in contact. This includes:
 Bedroom, washroom, and surfaces like door handles, cupboard
handles, water taps, over handles, grab-rails in corridors and stairwells,
switch board, kettles and phones.
 Most of the household disinfectants require a contact time5 of at least
10 minutes for proper disinfection.
 Equipment require an immersion time of at least 30 minutes for proper
disinfection.
 Clean washroom with regular detergents and then with disinfectant.
 Clean and dry the equipment used for cleaning and disinfection after each
use.
 Clean and wash Latex Gloves with soap and then decontaminate with
(0.1%) chlorine solution (1 part bleach and 10 parts water).
3. MANAGING CONTACTS
Persons (including caregivers and health care workers) who have been exposed to
confirmed or suspected COVID19 patients, are considered contacts. Contacts
must be advised to monitor their health for 14 days from the last day of possible
contact with the patient. The contacts should:
 Practise all the preventive steps detailed earlier
 Wear masks
 Stay at home as much as possible
 Avoid contact with other people
 Avoid public transport and public places
 Wash hands with soap and water for at least 20 seconds after entering the
house or touching anything that may have been contaminated.
4. RECOVERING AFTER COVID-19

Even after testing negative on PCR, following symptoms may last for weeks or
possibly months:
 Severe fatigue
 Ongoing breathlessness
 Muscle weakness
 Cough
 Difficulties in remembering things/confusion
4
Graphics: Wakhra Studios
5
Dwell time, or contact time, is the amount of time disinfectants need to remain wet on surfaces to properly
disinfect. It may range from 30 seconds to 10 minutes or more for different disinfectants and different organisms.
10
 Anxiety and Low mood
MANAGING FATIGUE
Routine tasks and chores like housework, bathing, getting dressed or climbing
stairs may be more difficult and tiring in the beginning. Patient must:
 Rest well
 Keep frequently used items in easily accessible places.
 Perform tasks at a moderate rate and avoid rushing.
 Allow plenty of time for rest and relaxation.
 Use a timer to take mandatory breaks, initially every 30 minutes, and later
increasing to 1,2 3 hours as the energy gets fully replenished
 Take a morning or afternoon nap prior to activities to build up energy.
 Breathe easily and properly during activities.
 Use a shower seat and a hand-held shower head while taking a bath
BREATHLESSNESS AND COUGH

This may take time to settle.
 Practise breathing exercises mentioned in section 2.3.2 and Annexes 6, 7
and 8.
 Ensure good air circulation in the room
 Use wet flannel to cool the area around the nose and mouth to reduce the
sensation of breathlessness
 Stay well-hydrated
 Inhale steam
 Drink warm honey and lemon or another warm drink to soothe the throat
 In case of cough with sputum, try lying on either side to drain the sputum
 Also see Annex 9 and 10 for exercises to clear chest.
5. COVID19 – SPECIAL CASE MANAGEMENT

5.1. COVID-19 IN CHILDREN
Children can also be protected using the same precautions listed earlier.
Improve Immunity: Ensure a good routine, with adequate sleep, exercise and
nutritious diet. If under 5 years of age, children must have their multi-vitamins
daily. If over 5 years of age, they don’t need multivitamins, but they do need 800iu
of vitamin D every day.
Reduce anxiety: Limit discussions about COVID-19 in front of children. Answer
their COVID-19 related questions honestly and calmly. Reassure and teach them
how they can protect themselves and their friends.
Managing signs and symptoms: Most children will have much milder illness than
adults, with mild to moderate symptoms only, that can be managed safely at
home. It is much rarer for children to develop serious complications. Most
common symptoms are fever and dry cough. Also see Annex 13.
5.2. COVID19 IN PREGNANT WOMEN

All the evidence to-date suggests that pregnant women are not at any higher risk
than any other healthy adults if they develop coronavirus. There is also no
evidence suggesting any developmental problems with the unborn baby. A few
babies have been diagnosed with coronavirus soon after birth but it is not clear
whether they were infected during pregnancy or after delivery. In all these cases
though, the newborn babies have been well.
11
5.3. COVID-19 AND BREAST-FEEDING
There is no evidence that suggests that the virus can be passed on in breastmilk.
The benefits of breastfeeding and the protection it gives to the baby outweighs
any potential risk of transmission of coronavirus through breastmilk. The
following precautions must be practiced before breast-feeding:
 Mother must wash hands before touching her baby, breast pump or
bottles
 Mother must wear a face mask while breastfeeding
 Mother should try to avoid coughing or sneezing on her baby
12
ANNEXURE
Annex 1 - LIST OF ESSENTIAL ITEMS TO STOCK
Essential  Stock up on any prescribed medication that you
Medicines regularly take
 Tab Panadol/ Paracetamol 250 mg/500 mg
 Tab Loratadine 10 mg
 Tab Aspirin 150 mg
 Menthol Crystals/ Vicks VapoRub for Steam inhalation
 Tab Azithromycin 500 mg
 Acetylcysteine 200mg powder/soluble granules
(locally available as Mucolator);
 ORS sachets
 Tab/Syrup Multi-vitamins (C, D3 and Zinc);
 Tab Montelukast 10 mg
 Please take medication only after consulting the
doctor. The normal dosage and frequency of medicines
has been provided in section 2.3.3: Clinical Care
Equipment  Thermometer
 Pulse Oximeter
 Digital or manual blood pressure apparatus
 Nebulizer
Supplies and  Face Masks

protective  Disposable Gloves for clinical care
gear  Rubber gloves for cleaning
 Hand Sanitizer (Alcohol-based)
 Cotton swabs
 Soap
 Tissue Papers and wipes
 Single-use long sleeved aprons/gowns
 Plastic aprons
 Personal Protective Equipment (PPE)
House-  Detergent for washing clothes (soap, liquid or powder)

Keeping  Disinfectant solution in spray bottles (1-part bleach or
Supplies Dettol + 10 parts water)
 Gloves, masks, protective aprons
 Dusters
 Garbage/ Dust Bins
 Plastic liners/garbage bags liners
13
6
Annex 2 -
Graphics: WHO Guidelines

WEARING PERSONAL PROTECTION EQUIPMENT (PPE)
14
Annex 3 -
WEARING THE MASK
15
Annex 4 - REMOVING PERSONAL PROTECTION EQUIPMENT (PPE)
Annex 5 - LIST OF WEBSITES TO FOLLOW AND STAY UPDATED

 WHO on general information about COVID-19
 WHO – Latest updates on COVID-19
 WHO – Advice for Public
 Government of Pakistan Website on COVID-19
 WHO Guidelines on Home care for patients with COVID-19
16
Annex 6 - MANAGING BREATHLESSNESS AT HOME7
7
Higginson IJ, Maddocks M, Bayly J, Brighton LJ, Hutchinson A, Booth S, OgdenM, Farquhar M. on behalf of the
NIHR Applied Research Collaborative Palliative and End of Life Care Theme. April 3rd2020. Managing your
breathlessness at homeduring the corona virus(COVID-19)outbreak.
17
Annex 7 - POSITIONS TO MANAGE BREATHLESSNESS8
Annex 8 - BREATHING A RECTANGLE Practical & Handy Handbook | Living in the Times of COVID-19 | Mobile Version 3.0
8 Homerton University Hospital. (2020). ACERS. Post COVID-19 Patient

Information Pack
18
Annex 9 -
EXERCISES TO CLEAR CHEST
Annex 10 - POSITIONS TO KEEP CHEST CLEAR
19
Annex 11 - SLEEPING TIPS
 Keep a consistent sleep schedule. Get up at the same time every day, even
on weekends or during vacations.
 Set a bedtime that is early enough for you to get at least 7 hours of sleep.
 Don’t go to bed unless you are sleepy.
 If you don’t fall asleep after 20 minutes, get out of bed.
 Establish a relaxing bedtime routine.
 Use your bed only for sleeping.
 Make your bedroom quiet and relaxing.
 Keep the room at a comfortable, cool temperature.
 Limit exposure to bright light in the evenings.
 Turn off electronic devices at least 30 minutes before bedtime.
 Don’t eat a large meal before bedtime. If you are hungry at night, eat a light,
healthy snack.
 Exercise regularly and maintain a healthy diet.
 Avoid consuming caffeine in the late afternoon or evening.
 Reduce your fluid intake before bedtime.
Annex 12 - OTHER RESOURCES FOR MENTAL HEALTH

 Sleep Hygiene Checklist
 How Much Sleep Do I Need?
 How much physical activity is recommended for me?
 How do I maintain a healthy diet?
 Urdu version of breathing exercises:
https://www.youtube.com/watch?v=u7kDAIsSWyQ
 Progressive Muscle Relaxation:
https://www.youtube.com/watch?v=GZ9PHsbt-m4
20
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If your child has any of the following: You need urgent help:
•If Becomes
your child has
pale, any and
mottled of the following:
feels abnormally cold to the touch You need urgent help:
If your child has any of Go to theneed
nearest A&E department
• Becomes pale, mottled andthe following:
feels abnormally cold to the touch
• Has pauses in their breathing (apnoeas), has an irregular
You urgent help:
or phone
Go to the nearest 999
A&E department
•• breathing
Becomes
Has pauses pale,
patternmottled
in their andgrunting
orbreathing
starts feels abnormally
(apnoeas), hascold to the touch
an irregular or phone
Go to the nearest 999
A&E department
breathing
•• Severe
Has pauses patternin or
in their
difficulty starts grunting
breathing
breathing (apnoeas),
becoming has anorirregular
agitated unresponsive
You need or phone 999
•• Is breathing
Severe pattern
difficulty inor starts grunting
breathing becoming agitated or unresponsive urgent help.
going blue round the lips
• Severe difficulty in breathing
the lips becoming agitated or unresponsive
Call your
•• HasIs going blue round
a fit/seizure
• Is going blue round the lips doctor
•• Becomes
Has a fit/seizure
extremely distressed (crying inconsolably despite immediately.
•• distraction),
Has a fit/seizure
Becomes confused,
extremely very lethargic
distressed (crying(difficult to wake)
inconsolably or
despite
• unresponsive
distraction),
Becomes confused,
extremely very lethargic
distressed (crying(difficult to wake)
inconsolably or
despite
unresponsive
distraction),
• Develops confused,
a rash that doesvery lethargic
not disappear(difficult to wake)(the
with pressure or
unresponsive
• ‘Glass test’)
Develops a rash that does not disappear with pressure (the
•• Has‘Glass
Developstest’)
a rash
testicular thatespecially
pain, does not disappear
in teenagewith
boyspressure (the
• ‘Glass test’) pain, especially in teenage boys
Has testicular
• Has testicular pain, especially in teenage boys
If your child has any of the following: You need to contact a doctor or
•If Is
your child
finding hastoany
it hard of the
breathe following:
including drawing in of the muscles You need to contact
nurse a doctor or
today.
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• below
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at the following:
including
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You need to today.
contact a doctor or
below their
• (recession)
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head
hard at their
bobbing
breathe neck ordrawing
including between intheir ribs
of the muscles nurse today.
Please ring your GP surgery or call
• (recession)
below
Seems their or head
lower
dehydrated bobbing
ribs,
(dry atmouth,
their neck or between
sunken eyes, no their
tears,ribs
drowsy Please ring
Contact NHSyour
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- dial 111 or call
• (recession)
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Please ring
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surgery
•• orbecoming
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or irritable drowsy
(unable NHS is
111 - dial 111
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or
• to passing
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• they
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down However,
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they remain drowsy or or
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• Has to settle
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complains theirup)
or picking
of muscle fever
paincoming down
- especially if However,
current coronavirus
times,for we recognise
access to a healthduring
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atcare
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they remain drowsy or irritable despite muscle
their fever coming down persist
•• Babies
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3 months or of complains
age with a oftemperature painabove 38°C / current
more
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symptoms access to a be
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fordelayed.
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•• Infants
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100.4°F3-6 under 3 months
months of age of with
age with a temperature
a temperature above above
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have
and you
not been
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100.4°F
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symptoms
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and you either aforGP
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•• ForInfants 3-6 months of age with a temperature above 39°C /
able
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111,
102.2°F
all infants and children with a fever above 38°C for more
102.2°F
totoyour thendoctor,
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take either a GPtoorthe
your child
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• than
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5 days.
• For all
takethen yourtake your child
nearest
child A&E to the
• Is than 5 infants
gettingdays. and children with a fever above 38°C for more
worse or if you are worried to the nearest nearest A&E
than 5 days.
•• HasIs getting worse
persistent or if you
vomiting are worried
and/or persistent severe abdominal pain hospital.
•• Is getting
Has blood worse
persistent or if youand/or
vomiting are worried
• Has in their poo or wee persistent severe abdominal pain
•• Has
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blood in vomiting
their poo orand/or
wee persistent severe abdominal pain
• Any limb injury causing reduced movement, persistent pain or
•• head
Has blood
Any limb
injury incausing
their
injury poo
causing orreduced
wee crying
persistent movement, persistent pain or
or drowsiness
headlimb
• Any injury causing
injury causingpersistent
reduced crying or drowsiness
movement, persistent pain or
head injury causing persistent crying or drowsiness
If none of the above features are present Self care
•If You
none
canof the above
continue features
to provide are care
your child present
at home. Information Self care
If none ofcontinue
the above features are present Continue providingSelfyour
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• is
You can
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provide your child
Choices care at home. Information
Continue
home. If youproviding your child’sabout
are still concerned care yo
a
•• is also
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Additional adviceonis
continue toNHS Choices
provide
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to families at home. Information
for coping Continue
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call your child’sabout
still concerned care yo
a
• is also available
Additional
with crying adviceonisbabies
of well NHS Choices
available to families for coping Continue to NHS 111 - dial 111
home. Ifchild,
you are
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NHS concerned
111 - dial about
111 yo
••
with cryingadvice
Additional
Additional
of wellisbabies
advice is available for
available to families
childrenfor coping
with
care for your
child, call NHS 111 - dial 111
• with crying
Additional
complex of well
advice
health isbabies
needs available for children with
and disabilities. child at home.
• complex health
Additional adviceneeds and disabilities.
is available for children with
complex health needs and disabilities.
RC
RCPC
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Pu b lish ed 20 20
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20 20 e of Paed iat rics an d Ch ild Healt h is a reg ist ered ch arit y
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ed 20 20 e of Paed iat rics an d Ch ild Healt h is a reg ist ered ch arit y
RCPC
Royal College of
Paediatrics
Royal
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and
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of Child
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Royal College of
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ildren
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an d We ales (10 5774 4)an
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inCh ildren’
Annex 14 - GETTING TESTED
Th e Royal of Paed iat rics ild Healt is a reg ist ered ch arit y
in En g lan d an d W ales (10 5774 4)an d in Scot lan d (SCO38299).
Paediatrics Child
LeadingthewayinChildren’
HOW TO GET CHECKED

If you suspect any of the signs and symptoms mentioned in section 1.1:
 Visit a government designated public or private hospital. All district
headquarter hospitals and tertiary care hospitals across the country are
equipped to collect samples for coronavirus.
 At the hospital, a doctor will check you for symptoms, travel history and
other questions to determine if you may have coronavirus.
 If the doctor rules out suspicion of coronavirus, you will be sent back.
 If the doctor comes to the conclusion that you are manifesting symptoms,
a swab of your saliva will be taken and sent to one of the designated
facilities that have coronavirus testing equipment. This testing will be done
free of cost. You may also be sent back home with instructions on isolation
without being tested.
 If you are interested in prompt testing, you may go to private laboratories,
and pay a fee to get tested.
21
FACILITIES CONDUCTING TESTS FOR CORONAVIRUS
Sindh
 Advanced Diagnostic Centre - Karachi
 Aga Khan University Hospital - Karachi
 Chughtai Lab, Karachi
 Dow University of Health Sciences, Ojha - Karachi
 Dr Ruth Pfau Civil Hospital - Karachi
 Ziauddin Hospital - Karachi
 Indus Hospital - Karachi
 PNS Shifa - Karachi
 SIUT - Karachi
 Gambat Institute of Medical Sciences - Khairpur
 Liaquat University of Medical and Health Sciences - Hyderabad
Punjab
 Provincial Public Health Reference Lab (PPHRL), PHSD
 Shaukat Khanum Cancer Hospital - Lahore
 Pakistan Kidney And Liver Institute - Lahore
 Nishtar Hospital - Multan
 Chughtai Testing Laboratory (home collection available as well)
 National Institute of Health - Islamabad
 Institute of Public Health - Lahore
 Allied hospital - Faisalabad
 Civil Hospital - Bahawalpur
Khyber Pakhtunkhwa
 Khyber Medical University - Peshawar
 Hayatabad Medical Complex - Peshawar
 Ayub Teaching Hospital - Abbottabad
 Saidu Teaching Hospital - Swat
 Mufti Mehmood Memorial Teaching Hospital - DI Khan
 Rehman Medical Institute - Peshawar
 North West General Hospital - Peshawar
 Anwar lab - Peshawar
Balochistan
 Fatima Jinnah Hospital - Quetta
Azad Jammu and Kashmir
 Abbas Institute of Medical Sciences - Muzaffarabad
 Sheikh Khalifa bin Zayed al Nahayan Hospital (CMH) - Rawalakot
 Divisional Headquarters Hospital - Mirpur
Gilgit Baltistan
 All district hospitals in the area are equipped to collect samples which are
then sent to a lab in Gilgit or Skardu for testing
In addition to these facilities, citizens can visit their nearest public tertiary
healthcare centre or district headquarter hospital for screening. This list will
continue to be updated in subsequent versions of these guidelines.
22
Annex 15 - LIST OF DOCUMENTS AND GUIDELINES REVIEWED
 WHO (2020) Critical preparedness, readiness and response actions for COVID-19.
Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-
2019/technical-guidance/critical-preparedness-readiness-and-response-actions-
for-covid-19. (Accessed: 27 March 2020).
 WHO (2020) Considerations for quarantine of individuals in the context of
containment for coronavirus disease (COVID-19).
 WHO (2020) Home care for patients with COVID-19 presenting with mild
symptoms and management of their contacts.
 WHO (2020) Isolation Rooms-International Health Facility Guidelines.
 WHO (2020). Nutrition Advice for adults during COVID-19 outbreak
 Center for Disease Control and Prevention (CDC) (2020). Recommended
precautions for household members, intimate partners, and caregivers in a
nonhealthcare setting. Available at: https://www.cdc.gov/coronavirus/2019-
ncov/hcp/guidance-prevent-spread.html (Accessed: 27 March 2020).
 Center for Disease Control and Prevention (CDC) (2020) Coronavirus Disease
2019 (COVID-19). Available at: https://www.cdc.gov/coronavirus/2019-
ncov/symptoms-testing/symptoms.html (Accessed: 25 March 2020).
 Center for Disease Control and Prevention (CDC) (2020) Coronavirus (COVID-19).
Available at: https://www.cdc.gov/coronavirus/2019-ncov/index.html
(Accessed: 24 March 2020).
 European Centre for Disease Prevention and Control. (2020). Leaflet:
information on self-isolation and quarantine after exposure to COVID-19.
Available at: https://www.ecdc.europa.eu/en/publications-data/leaflet-
information-self-isolation-and-quarantine-after-exposure-covid-19 (Accessed:
24 March 2020)
 UNICEF (2020) Coronavirus disease (COVID-19): What parents should know.
Available at: https://www.unicef.org/pakistan/coronavirus-disease-covid-19-
what-parents-should-know (Accessed: 24 March 2020).
 Public Health England. (2020). Guidance: Stay at home: guidance for households
with possible coronavirus (COVID-19) infection.
https://www.gov.uk/government/publications/covid-19-stay-at-home-
guidance/stay-at-home-guidance-for-households-with-possible-coronavirus-
covid-19-infection (Accessed: 24 March 2020)
 Public Health England (2020) Guidance on social distancing for everyone in the
UK. Available at: https://www.gov.uk/government/publications/covid-19-
guidance-on-social-distancing-and-for-vulnerable-people/guidance-on-social-
distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable-
adults. (Accessed: 27 March 2020).
 John Hopkins Medicine. (2020). Coronavirus, Social Distancing and Self-
Quarantine. Available at: https://www.hopkinsmedicine.org/health/conditions-
and-diseases/coronavirus/coronavirus-social-distancing-and-self-quarantine
(Accessed: 28 March 2020).
 Cleveland Clinic. (2020). COVID-19: Understanding Quarantine, Isolation and
Social Distancing in a Pandemic. Available at:
https://health.clevelandclinic.org/covid-19-understanding-quarantine-isolation-
and-social-distancing-in-a-pandemic/ (Accessed: 28 March 2020).
 National Institute for Health Research (2020). Managing breathelessness in
COVID19. https://www.kcl.ac.uk/cicelysaunders/resources/khp-gp-
breathlessness-resource.pdf
 Government of Ireland (2020) Coronavirus (COVID-19) Public Information
Booklet.
 Government of Pakistan (2020) National Action Plan for Corona virus disease
(COVID-19) Pakistan.
 Homerton University Hospital. (2020). ACERS. Post COVID-19 Patient
Information Pack. NHS.
23
24

COVID19 Home Management HandBook Version 3 (15june2020)

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COVID19 Home Management HandBook Version 3 (15june2020)

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Home-Management of Mild Cases

COVID-19 Released Sunday 14 June 2020

If you are suspecting COVID19, have been in

Version 1.0 released Wednesday, 1 April 2020

EDITING, REVIEW AND COMPILATION

SIGNS AND SYMPTOMS

1.2. WHO IS AT RISK?

1.3. HOW TO AVOID GETTING INFECTED?

Federal 1166, 115 (Edhi)

2.2. WHAT TO DO IF YOU HAVE A SUSPECTED OR CONFIRMED

2.2.1. IMMEDIATE ACTIONS

2.3. FOR THE FIRST SEVEN DAYS

2.3.1. MAKE ARRANGEMENTS FOR A SEPARATE ROOM

2.3.2. POSITIONING AND BREATHING

2.3.3. CLINICAL CARE

 Aches and pains

2.3.4. FOOD MANAGEMENT & UTENSILS HANDLING

ENSURING NUTRITIOUS DIET

CLEANING THE ROOM DURING ISOLATION

 Disinfect all surfaces of washing machine after handling laundry of

2.4. AFTER FIRST SEVEN DAYS

CLEANING/DECONTAMINATING THE ROOM AFTER ENDING ISOLATION

4. RECOVERING AFTER COVID-19

BREATHLESSNESS AND COUGH

5. COVID19 – SPECIAL CASE MANAGEMENT

5.2. COVID19 IN PREGNANT WOMEN

Supplies and  Face Masks

House-  Detergent for washing clothes (soap, liquid or powder)

Graphics: WHO Guidelines

Annex 5 - LIST OF WEBSITES TO FOLLOW AND STAY UPDATED

8 Homerton University Hospital. (2020). ACERS. Post COVID-19 Patient

Annex 10 - POSITIONS TO KEEP CHEST CLEAR

Annex 12 - OTHER RESOURCES FOR MENTAL HEALTH

HOW TO GET CHECKED

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